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Colorectal cancer: How do we approach health disparities?

Colorectal cancer: How do we approach health disparities?. Marta L. Davila, MD, FASGE University of Texas MD Anderson Cancer Center. Colorectal cancer (CRC) Facts. Third most common cause of cancer Second leading cause of cancer-related deaths in men and women in the US

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Colorectal cancer: How do we approach health disparities?

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  1. Colorectal cancer:How do we approach health disparities? Marta L. Davila, MD, FASGE University of Texas MD Anderson Cancer Center

  2. Colorectal cancer (CRC)Facts • Third most common cause of cancer • Second leading cause of cancer-related deaths in men and women in the US • An estimated 143,000 cases of CRC are expected to occur in 2012 American Cancer Society. Cancer facts and figures 2012. Atlanta: American Cancer Society; 2012

  3. Colorectal cancerFacts • 51, 690 deaths from CRC are expected to occur in 2012 • Americans have a 5% lifetime risk for CRC • Rare before age 40 in both men and women, with 90% of cases occurring after age 50

  4. Colorectal cancerFacts • Incidence of CRC has been declining in the US by 2-3% per year over the last 15 years • CRC screening probably accounts for this decline by early detection and removal of polyps • Good evidence shows that screening reduces mortality from CRC

  5. Polyp to Cancer Progression A. Sessile polyp B. Pedunculated polyp C. Colon cancer Figure available at: http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease3&organ=6&disease=36&lang_id=1. Accessed March 18, 2009.

  6. Colorectal cancerFacts • Modifiable factors associated with increased risk of CRC: • Obesity • Physical inactivity • Diet high in red or processed meat • Alcohol consumption • Long-term smoking • Low intake of fruits and vegetables • Early identification of patients with genetic conditions

  7. Cancer health disparities • Definition: “..adverse differences noted in cancer epidemiology that exist among specific groups in the U.S.” • Further defined by new cases (incidence), deaths (mortality) and associated psychosocial and financial burden • These populations are characterized by age, education, ethnicity/race, gender, income and geographic location

  8. Cancer disparitiesCauses • Social • Economic • Cultural • Health system factors • Inequities in work, wealth, education, housing, and barriers to prevention, early detection and treatment services

  9. American Cancer Society. Colorectal Cancer Facts and Figures. 2011-2013 Atlanta: American Cancer Society. 2011

  10. American Cancer Society. Colorectal Cancer Facts and Figures. 2011-2013 Atlanta: American Cancer Society. 2011

  11. CRC disparitiesAfrican-Americans • Dietary / Nutritional factors • Rates of physical inactivity • Variability in screening rates • Lower use of diagnostic testing • Decreased access to high-volume hospitals and subspecialists • Genetic susceptibilities • Cancer biology

  12. American Cancer Society. Colorectal Cancer Facts and Figures. 2011-2013 Atlanta: American Cancer Society. 2011

  13. Colorectal cancer screening guidelines

  14. CRC screening guidelinesUS Preventive Services Task Force (USPSTF) • For average-risk adults, screening should begin at age 50 and continue until age 75 • CRC screening in adults 76 to 85 years should be individualized Ann Intern Med 2008;149:627-37

  15. CRC screening guidelinesAmerican Cancer Society (ACS) , US Multi-society Task Force on Colorectal Cancer (USMSTF) and the American College of Radiology (ACR) • Average-risk adult should start screening at age 50 Ann Intern Med 2012;156:378-386

  16. American Cancer Society. Colorectal Cancer Facts and Figures. 2011-2013 Atlanta: American Cancer Society. 2011

  17. CRC screeningBarriers • Cost and lack of access to health care • Physician variability regarding screening recommendations • Poor transmission of the benefits and risks of not getting screened • Personal barriers • Fear, embarrassment, distrust of the medical community

  18. Strategies to increase CRC screening • Prompt one-on-one discussion about the potentially life-saving importance of screening • Remove financial barriers to screening • Help patients navigate through the healthcare system • Use educational prompts to educate the community about Colonoscopy and other forms of screening

  19. Strategies to reduce CRC disparities • Support increased funding for colorectal cancer programs and research at the NIH • Support the CDC Colorectal cancer Control Program • Goal: to increase CRC screening rates in adults >50 years to 80% • Support community programs targeting racial/ethnic minorities

  20. Summary • Colorectal Cancer is a common, yet preventable disease that affects 140,000 individuals annually • Colorectal Cancer mortality has declined over the past 3 decades largely due to increased screening • Disproportionately higher cancer incidence and mortality rates in minority populations may be directly related to barriers to screening • Identifying these barriers is key to improved outcomes

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